Provider Demographics
NPI:1477251858
Name:LOHMEYER, BRADLEY RAFAEL
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:RAFAEL
Last Name:LOHMEYER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12645 SUNNY VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-9443
Mailing Address - Country:US
Mailing Address - Phone:760-780-9413
Mailing Address - Fax:
Practice Address - Street 1:3333 CONCOURS STE 4102
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-6564
Practice Address - Country:US
Practice Address - Phone:909-240-1764
Practice Address - Fax:909-259-2369
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician